Provider Demographics
NPI:1457003832
Name:GLAZER, ABIGAIL E (CPNP-PC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:E
Last Name:GLAZER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:ELISE
Other - Last Name:WILWANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-0307
Mailing Address - Country:US
Mailing Address - Phone:770-887-1670
Mailing Address - Fax:770-887-0978
Practice Address - Street 1:475 TRIBBLE GAP RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2478
Practice Address - Country:US
Practice Address - Phone:706-381-6125
Practice Address - Fax:770-781-9937
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN299103363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics